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Hypoglycemia and hyperglycemia in extremely low-birth-weight infants

Background

Glucose metabolism disorders are common in extremely low birth weight (ELBW) infants and are associated with high morbidity and mortality [19]. This study was conducted to evaluate the prevalence and risk factors associated with both hypo and hyperglycemia in ELBW infants.

Materials and methods

All inborn ELBW neonates admitted to our NICU during a 5-year period were eligible for this retrospective analysis. Exclusion criteria were: birth weight (BW) <400 grams, major congenital malformations, death during the first 24 hours of life. Hypoglycemia was defined as blood glucose level (BGL) ≤45 mg/dL; hyperglycemia as BGL>240 mg/dL in a single determination or >180 mg/dL in two determinations at 2-hour intervals. Continuous intravenous insulin infusion was started after an ineffective glucose restriction.

Results

Of 195 ELBW infants, 29 (14.8%) were excluded and 166 (GA 26.7 2.1 weeks, BW 751 152 grams) were analyzed and grouped to their BGL. Normoglycemia was observed in 79 neonates (47.6%) (N-Group); 80 neonates (52.4%) showed abnormal BGL: 21 (12.7%) were hypoglycemic (Hypo-Group), 53 (31.9%) hyperglycemic (Hyper-Group) and 13 (7.8%) showed both hypoglycemia and hyperglycemia (Hypo&Hyper-Group). Clinical characteristics of the groups are reported in Table 1. Hypo-Group respect to N-Group showed a higher rate of small for gestational age (SGA) neonates (p=0.03). Hyper-Group in comparison to N-Group showed a tendency toward a lower GA (p=0.05), lower BW (p<0.001), higher sepsis rate (p<0.001), higher rate of treatment with inotropic agents (p=0.02), corticosteroids (p=0.006) and nonsteroidal antiinflammatory drugs (p=0.01). Hypo&Hyper-Group respect to N-Group showed similar GA, lower BW (p<0.001), higher sepsis rate (p<0.01), higher rate of inotropic treatment (p=0.04). Insulin was administered in 35 neonates (66%) of Hyper-Group and in 8 neonates (61.5%) of Hypo&Hyper-Group. Intraventricular Hemorrhage ( IVH) rate was higher in Hyper-Group and Hypo&Hyper-Group respect to N-Group (p=0.002) as well as IVH grade3 (p=0.001 and p=0.02, respectively).The rate of both Retinopathy of Prematurity ( ROP) and ROP ≥stage 2 in survived neonates was higher in Hyper-Group respect to N-Group (p=0.008 and p=0.002, respectively). Mortality was similar among the groups (Table 2).

Table 1 Demographic data and risk factors in the study groups
Table 2 Complications and outcome in the study groups

Conclusions

Among ELBW infants, hypoglycemia occurs more frequently in SGA neonates, while hyperglycemia alone or a marked variability of BGL (hypo and hyperglycaemia) is more common in sick neonates. High rate of glucose homeostasis disorders highlights the importance of carefully monitoring BGL in order to a prompt management. Continuous glucose monitoring recently used in neonates [10] might be a useful tool for monitoring glucose changes also in ELBW neonates.

References

  1. 1.

    Lucas A, Morley R, Cole TJ: Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. British Med J. 1988, 297: 1304-1308. 10.1136/bmj.297.6659.1304.

    CAS  Article  Google Scholar 

  2. 2.

    Alkalay AL, Sarnat HB, Flores-Sarnat L, Simmons CF: Neurologic aspects of neonatal hypoglycemia. Isr Med Assoc J. 2005, 7 (3): 188-192. Review. Erratum in: Isr Med Assoc J. 2005;7(4):267

    PubMed  Google Scholar 

  3. 3.

    Duvanel CB, Fawer CL, Cotting J, Hohlfeld P, Matthieu JM: Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants. J Pediatr. 1999, 134: 492-498. 10.1016/S0022-3476(99)70209-X.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA: Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol. 2006, 26: 730-736. 10.1038/sj.jp.7211593.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Hays SP, Smith EO, Sunehag AL: Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics. 2006, 118: 1811-1818. 10.1542/peds.2006-0628.

    Article  PubMed  Google Scholar 

  6. 6.

    Garg R, Agathe AG, Donohue PK, Lehmann CU: Hyperglycemia and retinopathy of prematurity in very low birth weight infants. J Perinatol. 2003, 23: 186-194. 10.1038/sj.jp.7210879.

    Article  PubMed  Google Scholar 

  7. 7.

    Au SC, Tang SM, Rong SS, Chen LJ, Yam JC: Association between hyperglycemia and retinopathy of prematurity: a systemic review and meta-analysis. Sci Rep. 2015, 5: 9091-

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  8. 8.

    Sabzehei MK, Afjeh SA, Shakiba M, Alizadeh P, Shamshiri AR, Esmaili F: Hyperglycemia in VLBW infants; incidence, risk factors and outcome. Arch Iran Med. 2014, 17 (6): 429-434.

    PubMed  Google Scholar 

  9. 9.

    Auerbach A, Eventov-Friedman S, Arad I, Peleg O, Bdolah-Abram T, Bar-Oz B, Zangen DH: Long duration of hyperglycemia in the first 96 hours of life is associated with severe intraventricularhemorrhage in preterm infants. J Pediatr. 2013, 163 (2): 388-393. 10.1016/j.jpeds.2013.01.051.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Signal M, Le Compte A, Harris DL, Weston PJ, Harding JE, Chase JG, CHYLD Study Group: Using Stochastic modelling to identify unusual continuous glucose monitor measurements and behaviour, in newborn infants. Biomed Eng Online. 2012, 11: 45-10.1186/1475-925X-11-45.

    PubMed Central  Article  PubMed  Google Scholar 

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Correspondence to Maria Pia De Carolis.

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De Carolis, M.P., Rubortone, S.A., Cocca, C. et al. Hypoglycemia and hyperglycemia in extremely low-birth-weight infants. Ital J Pediatr 41, A7 (2015). https://doi.org/10.1186/1824-7288-41-S1-A7

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Keywords

  • Hyperglycemia
  • Blood Glucose Level
  • Hypoglycemia
  • Continuous Glucose Monitoring
  • Major Congenital Malformation